New perspectives on SGLT2 inhibitors in diabetic kidney disease: focus on hematology and inflammation

Chronic kidney disease (CKD) is the word health burden, affecting about 9.3% of the world`s population. Type 2 diabetes is the leading cause of CKD. These conditions are independent risk factors for kidney failure, cardiovascular disease, and death. Thus, new treatments to improve the prognosis for people with diabetes and CKD are desired.
Sodium-glucose transporter2 (SGLT2) inhibitors cause sugar urine and were originally developed as anti-diabetes medication. Clinical trials of SGLT2 inhibitors revealed that these drugs reduced the risk of kidney and cardiovascular events beyond improvement in blood glucose levels. Now, SGLT2 inhibitors are widely used as CKD treatment for patients with and without diabetes. However, the mechanism by which SGLT2 inhibitors protect kidney is not fully understood.
In his PhD project, Akihiko Koshino assessed the effect of SGLT2 inhibitors on anemia and inflammation using data and bio-samples collected in clinical trials. This is because these two conditions are closely associated with kidney disease progression and cardiovascular disease. Akihiko and colleagues reported that SGLT2 inhibitors correct and prevent CKD-related anemia partly via their beneficial effect on iron metabolism. In addition, SGLT2 inhibitors reduced inflammatory markers in blood and urine, suggesting their anti-inflammatory properties.
These data provide mechanistic insights into the clinical benefits of SGLT2 inhibitors, help clinicians select patients more likely to benefit from the drug, and may aid the development of new CKD treatments targeting anemia and chronic inflammation.